Healthcare Provider Details

I. General information

NPI: 1609469543
Provider Name (Legal Business Name): FAITH & HOPE INDEPENDENT LIVING HEALTH SERVICES OF MS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

737 N STATE ST
JACKSON MS
39202-3006
US

IV. Provider business mailing address

737 N STATE ST
JACKSON MS
39202-3006
US

V. Phone/Fax

Practice location:
  • Phone: 769-524-6802
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. NEAL ANGRUM
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 318-381-8584